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射频及激光消融术治疗大隐静脉曲张的疗效研究

Effects of radiofrequency and laser ablation on treating great saphenous varicose veins

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目的 探讨射频及激光消融术治疗大隐静脉曲张的疗效.方法 选取 2018 年 1 月至 2021 年 1 月就诊于北京中医药大学附属护国寺中医医院血管外科行手术治疗的大隐静脉曲张患者 280 例为研究对象,根据手术方法不同分为射频组及激光组,射频组采用大隐静脉射频消融术(radiofrequency ablation,RFA)+泡沫硬化剂注射术+点式剥脱术,共 140 例患者,140 条患肢;激光组采用大隐静脉高位结扎+主干激光消融术+泡沫硬化剂注射术+点式剥脱术,共 140 例患者,140 条患肢.对比 2 组患者手术时间、术中出血量、住院时间、血小板(platelet,PLT)、D-二聚体(D-dimer,D-D)、视觉模拟量表(visual ana-logue scale,VAS)评分、静脉临床严重程度量表(venous clinical severity scale,VCSS)评分、并发症发生率、大隐静脉闭合及复发情况.结果 射频组患者手术时间、住院时间短于激光组患者,术中出血量少于激光组患者,差异均有统计学意义(P<0.05).2 组患者治疗后D-D水平均低于治疗前,射频组治疗后PLT水平降低,激光组治疗后PLT水平升高,射频组治疗后PLT和D-D水平低于激光组治疗后,差异均有统计学意义(P<0.05).射频组患者术后 6 h及 48 h VAS评分均低于激光组,差异有统计学意义(P<0.05).2 组患者术前VCSS评分比较差异无统计学意义(P>0.05);射频组患者术后 1 个月VCSS评分低于激光组患者,差异有统计学意义(P<0.05).2 组患者术后闭合及复发情况比较差异无统计学意义(P>0.05).术后射频组患者并发症发生率低于激光组,差异有统计学意义(P<0.05).结论 采用RFA治疗大隐静脉曲张,能降低患者术后PLT、D-D水平,有效控制静脉严重程度,减少并发症发生率,且无需高位结扎大隐静脉,更具微创性.
Objective To investigate the effects of radiofrequency and laser ablation on treating great saphenous varicose veins.Methods Totally 280 patients with great saphenous varicose veins who underwent vascular surgery in Department of Vascular Surgery,Huguosi Hospital Affiliated to Beijing University of Chinese Medicine,Beijing from January 2018 to January 2021 were selected as research subjects,and were divided into the radiofrequency group and laser group according to different surgical methods.The radiofrequency group(140 patients and 140 affected limbs)was treated with radiofrequency ablation(RFA)with great saphenous vein+ foam sclerosing agent injection+point stripping.The laser group(140 patients and 140 affected limbs)was treated with high ligation with great saphenous vein+endovenous laser ablation + foam sclerosing agent injection+point stripping.The surgical time,intraoperative blood loss,hospital stay,PLT,D-D,visual analogue scale(VAS)score,venous clinical severity scale(VCSS)score,complication rate,great saphenous vein closure and recurrence were compared between the patients of the 2 groups.Results The surgical time,hospital stay and intraoperative blood loss of the patients in the radiofrequency group were less or shorter than those in the laser group,with statistical significance(P<0.05).After treatment,the D-D level in the two groups were lower than those before treatment,the PLT level of radiofrequency group was lower than this before treatment,the PLT level of laser group was higher than this before treatment,and the PLT and D-D levels in the radiofrequency group were lower than those in the laser group,also with statistical significance(P<0.05).The VAS scores of the patients in the radiofrequency group at hour 6 and hour 48 after surgery were lower than those in the laser group,and there was also statistical significance,when comparisons were made between them(P<0.05).There was no statistical significance in preoperative VCSS scores between the two groups(P>0.05).One month after surgery,the VCSS scores of the patients in the radiofrequency group were significantly lower than those of the patients in the laser group,also with statistical significance(P<0.05).There were no significant differences in postoperative closure and recurrence,when comparisons were made between the two groups(P>0.05).The rate of postoperative complications in the radiofrequency group was significantly lower than that in the laser group,also with statistical significance(P<0.05).Conclusion The application of RFA for treatment of great saphenous varicose veins could reduce PLT and D-D levels of the patients after surgery,effectively control the severity of veins,and reduce the rate of complications.More importantly,it is more minimally invasive without high ligation of great saphenous vein.

Radiofrequency ablationEndovenous laser ablationGreat saphenous varicose veinsPlateletD-dimer

李志刚、孙默、兰勇

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100035 北京,北京中医药大学附属护国寺中医医院血管外科

100035 北京,北京中医药大学附属护国寺中医医院老年病科

北京医院血管外科

射频消融术 腔内激光消融术 大隐静脉曲张 血小板 D-二聚体

国家自然科学基金项目

31371160

2024

海军医学杂志
海军医学研究所

海军医学杂志

CSTPCD
影响因子:0.518
ISSN:1009-0754
年,卷(期):2024.45(3)
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